Search

Vascular endothelial growth factor (VEGF) plays a pivotal role in angiogenesis. Through regulation of haemodynamics, haematopoesis and the immune system, endocrinology and reparative processes, inhibition of VEGF can cause multiple adverse events. Previous data suggest that--even after intravitreal injection--systemic exposure might occur, thus bearing the risk of manifestation of side effects. Experience with intravenous administration of the antibody bevacizumab (Avastin) pointed to the potential consequences of a pan-VEGF blockade. The change of haemodynamic parameters implies a potential influence on the patient's morbidity. Studies already conducted during the approval process do not provide sufficient statistical power when evaluating whether systemic events significantly differ between the treatment and control groups. Retinal perfusion showed an altered vascular tone (change in vessel diameter) following anti-VEGF treatment. Physiological fenestration of the choroicapillaris is significantly reduced. Possible effects on the local oxygen supply in ischaemic tissue have to be considered. In contrast to destructive treatment modalities (laser, cryo), VEGF inhibitors promise the prompt and efficient response of retinal neovascularisation and the preservation of a better function (visual fields). The maturation of growing vessels (pericytes) and the secondary formation of membranes are limiting factors with regard to the time-point at which anti-VEGF therapy is most effective. A diligent use of the available drugs has to take into account which types of exudative retinopathy are showing no or only very limited response to the treatment.

Melanin granules in the retinal pigment epithelium (RPE) have many important functions which are not yet completely understood. Melanin in the RPE protects the cell from damage caused by oxidative stress. This pigment acts as a free radical sink and diminishes cytotoxic lipid peroxidation. Thus, melanin protects against light toxicity and against cytotoxic effects caused by ocular inflammation. Many enzymes, e.g. superoxide dismutase or carboanhydrase, are only activated in the presence of zinc. Melanin can store zinc and release it when required. The absence of melanin in patients with oculocutaneous albinism is accompanied by photophobia, poor visual acuity and nystagmus. Furthermore melanin is said to protect against damaging lipofuscin accumulation in the RPE. Melanosomes are involved in the lysosomal degradation pathways and possibly take part in the degradation of rod outer segments (ROS) in the RPE.

To analyze the elemental composition and topology of the extracellular compartments of the compound eye, the eyes of blowflies Calliphora vicina were rapidly frozen and ultrathin cryosections were freeze dried. Three zones of an ommatidium, peripheral cytosol of visual cells, rhabdomeres, and ommatidial cavities were analyzed by X-ray microprobe analysis. The ommatidial cavity was found to contain sodium and potassium in proportion similar to that in the blowfly hemolymph. Potassium-to-sodium ratio in a cytosol was typical for a cytosol. The rhabdomeres displayed an electrolyte content intermediate between the above compartments. Three topologically connected extracellular compartments were characterized by the experiments with tracers, monastral blue and lanthanum: (1) common intercellular space of ommatidia including peripheral clefts between the visual cells, both tracers entered this compartment; (2) the ommatidial cavity, which is not accessible for monastral blue, however, as revealed by our X-ray microanalysis, it was reachable for lanthanum; (3) rhabdomeric loops, which were accessible for lanthanum entering either via the cavity or from the common intercellular clefts. The above characteristics of the ionic content and topology of ommatidial compartments might suggest higher sodium and lower potassium content in the microvilli as compared with the cytosol. The rhabdomeric and “cavital” plasma membranes are assumed to be permeable for these ions so that a voltage of only 25–30 mV, negative inside, is probably formed across them, much lower than the known resting potential −60 mV across the peripheral plasma membrane of a visual cell.

Transplantation of autologous iris pigment epithelium (IPE) into the subretinal space has been suggested as one approach for the treatment of age-related macular degeneration. Autologous rabbit IPE cells were transplanted to the subretinal space to define the technique of transplantation and examine the survival of the transplanted cells.Autologous IPE cells were harvested by iridectomy and transplanted directly to the subretinal space of the fellow eye in 25 rabbits, using the parsplana approach. Animals were killed over a period of 5 months, and the retinas were examined morphologically by light and electron microscopy.Autologous IPE cells survived and formed a polarized monolayer above the retinal pigment epithelium in the subretinal space, with apical microvilli adjacent to photoreceptors. Fragments of phagocytosed photoreceptor rod outer segments were observed in phagosomes in the cytoplasm of IPE cells. Adjacent rod outer segments remained healthy throughout the experimental period. No signs of a cell-mediated immunologic response were observed.Our results show that in rabbits, autologous IPE cells transplanted to the subretinal space survive and do not adversely affect the photoreceptors. These results suggest that in humans, IPE cells might provide a substitute for retinal pigment epithelium cells as autologous transplants for the treatment of age-related macular degeneration.